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TNF Inhibitors Do Not Increase Risk of Herpes Zoster in RA Patients

Zoster risk the same for anti-TNF therapy and nonbiologic DMARDs (Mar. 6)

Patients with rheumatoid arthritis (RA) show disproportionate reactivation of herpes zoster compared with the general population. In a recent article in JAMA, investigators looked at whether the risk for reactivation is further increased by treatment with tumor necrosis factor (TNF) inhibitors.

The researchers identified new users of anti-TNF therapy among cohorts of patients with RA, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis from 1998 through 2007 in several large databases. The incidence of herpes zoster was compared between new anti-TNF users (n = 33,324) and patients treated with nonbiologic disease-modifying antirheumatic drugs (DMARDs) (n = 25,742).

The investigators identified 310 cases of herpes zoster among all new users of anti-TNF therapy compared with 160 cases among all users of nonbiologic DMARDs. A total of 266 zoster events occurred in the RA subgroup treated with TNF inhibitors (n = 24,384), for a crude incidence rate of 12.1 per 1,000 patient-years. In comparison, 90 zoster events were observed in the RA subgroup using nonbiologic DMARDs (n = 11,828), for a crude incidence rate of 12.7 per 1,000 patient-years. The adjusted incidence rates were similar between anti-TNF users and patients treated with nonbiologic DMARDs (adjusted hazard ratio = 1.00) and were comparable between all three anti-TNF drugs studied (infliximab, adalimumab, and etanercept).

The authors concluded that patients initiating anti-TNF therapy are at a similar risk of developing herpes zoster as patients who initiate nonbiologic medications, and that the risk of herpes zoster is similar among different TNF inhibitors. Within the RA cohort, the risk of herpes zoster was associated with increasing age, female sex, overall health status, and the use of higher-dose corticosteroids.

Source: JAMA; March 6, 2013.

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